Stitching device with long needle

ABSTRACT

A needle for use with an endoscopic stitching device includes a first end portion that is movable relative to a second end portion to allow the needle to convert from a first, mis-aligned orientation to a second, aligned orientation, thereby allowing the length of the needle in the aligned orientation to exceed the height of an end effector.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/465,865, filed Aug. 22, 2014, which claims benefit of and priority toU.S. Provisional Application No. 61/906,554, filed Nov. 20, 2013, andthe disclosures of each of the above-identified applications are herebyincorporated by reference in their entirety.

TECHNICAL FIELD

The present disclosure relates to devices, systems, and methods forendoscopic suturing or stitching and, more particularly, to endeffectors, systems and methods for endoscopic suturing and/or stitchingthrough an access device such as a cannula.

BACKGROUND

Increasingly, more and more surgical procedures are being performedthrough small openings (e.g., an incision or a natural opening) in theskin with the goal of reducing the invasiveness of the procedures. Ascompared to the larger openings typically required in traditionalprocedures, smaller openings result in less trauma to the patient. Byreducing the trauma to the patient, the time required for recovery isalso reduced. Generally, the surgical procedures that are performedthrough small openings in the skin are referred to as “endoscopic.” Ifthe procedure is performed on the patient's abdomen, the procedure isreferred to as “laparoscopic.” Throughout the present disclosure, theterm “minimally invasive” is to be understood as encompassing bothendoscopic and laparoscopic procedures. Cannulas can be utilized duringa minimally invasive procedure to facilitate passage of endoscopicinstruments.

In many surgical procedures, including those involved in endoscopicsurgery, it is often necessary to suture bodily organs or tissue.Endoscopic suturing procedures can be challenging due to the smallopenings through which the suturing of bodily organs or tissues must beaccomplished. Typically, the dimensions of the needles of endoscopicstitching devices are restricted by spatial limitations of the cannulasutilized to introduce the stitching devices into the surgical site.

It would be advantageous to have an end effector of an endoscopicstitching device that can be advanced through spatially limited accessdevices (e.g., cannulas) while supporting long needles. The advancementof stitching devices with long needles into surgical sites would enablea clinician to suture tissue with larger thickness as compared tostitching devices with short needles.

SUMMARY

Various embodiments of endoscopic stitching needles for use with anendoscopic stitching device are described, wherein the needle includes afirst end portion that is movable relative to a second end portion.Being movable, the first end portion of the needle can be in a first,mis-aligned orientation relative to the second end portion of theneedle. The first end portion of the needle can then be moved into asecond, aligned orientation relative to the second end portion of theneedle. The first end portion of the needle is adapted to engage a firstjaw member of the endoscopic stitching device and the second end portionis adapted to engage a second jaw member of the endoscopic stitchingdevice.

In embodiments of the needle, the first end portion pivots relative tothe second end portion.

In some embodiments of the needle, a connecting portion is disposedbetween the first and second end portions. The connecting portion may beformed of a flexible material adapted to enable the first end portion topivot relative to the second end portion.

In embodiments of the needle, the first end portion includes a lockingfeature and the second end portion includes a mating feature.

In certain embodiments of the needle, the connecting portion includes afirst arm member that extends from the first end portion and a secondarm member that extends from the second end portion. The first armmember may be secured to the second arm member by a pivot pin.

In embodiments of the needle, the first arm member includes the lockingfeature and the second arm member includes the mating feature. Thelocking feature and the mating feature are configured to selectivelyengage each other to at least temporarily lock the first and second endportions of the needle in an aligned configuration.

In certain embodiments of the needle, the first and second end portionsare separate, and the first end portion of the needle is adapted toconnect to the second end portion of the needle. The locking feature andthe mating feature can be adapted to connect to form the first andsecond end portions into a unitary arrangement. The first and second endportions can be movable relative to each other between a first,misaligned position and a second, aligned position. In embodiments, thefirst and second end portions are adapted to connect in the second,aligned position.

In embodiments of the needle, the first end portion is adapted toreceive the second end portion. The first end portion and the second endportion can support a compressible element adapted to enable the firstand second end portions to move between a first, compressed position anda second, extended position. The compressible element can include atleast one of a spring and a gas.

According to one aspect, an endoscopic stitching device includes an endeffector and a needle.

The end effector of the endoscopic stitching device includes a first jawmember and a second jaw member. The first jaw member is movable relativeto the second jaw member between an open state and a closed state. Theend effector defines a height in the closed state that is measuredbetween a bottom-most surface of the end effector and a top-most surfaceof the end effector.

In some embodiments, the needle defines a working length that is greaterthan the height of the end effector.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the disclosureand, together with a general description of the disclosure given above,and the detailed description of the embodiment(s) given below, serve toexplain the principles of the disclosure, wherein:

FIG. 1 is a perspective view of an embodiment of an endoscopic stitchingdevice in accordance with the present disclosure;

FIG. 2A is a side view of a distal end portion of an embodiment of anend effector of the endoscopic stitching device of FIG. 1, the endeffector shown in an insertion state and supporting an embodiment of aneedle of the present disclosure, the needle being shown in an unlockedstate;

FIG. 2B is a side view of the distal end portion of the end effector ofFIG. 2A shown in a stitching state and supporting the needle of FIG. 2Ain a locked state;

FIG. 2C is a side view of the distal end portion of the end effector ofFIGS. 2A and 2B shown in an open state and supporting the needle of FIG.2A in the locked state;

FIG. 3A is an enlarged, perspective view illustrating the needle ofFIGS. 2A and 2B in a locked state;

FIG. 3B is a perspective view of the needle of FIG. 3A shown in anunlocked state;

FIG. 4A is a perspective view of another embodiment of a needle shown inan unbent configuration;

FIG. 4B is a perspective view of the needle of FIG. 4A shown in a bentconfiguration;

FIG. 5 is a side, perspective view of a distal end portion of anotherembodiment of an end effector of the endoscopic stitching device of FIG.1 in an open state, this embodiment of the end effector shown supportinganother embodiment of a needle in accordance with the presentdisclosure;

FIGS. 6A-6C are progressive, front, cross-sectional views illustratingthe end effector of FIG. 5 coupling first and second end portions of theneedle of FIG. 5;

FIG. 7 is a side, cross-sectional view of the embodiment of the endeffector of FIG. 5 supporting another embodiment of a needle inaccordance with the present disclosure;

FIG. 8A is a side view, in partial cross-section, of another embodimentof an end effector of the endoscopic stitching device of FIG. 1 in anopen state supporting another embodiment of a needle in accordance withthe present disclosure, the needle being shown in an extended position;and

FIG. 8B is a side view, in partial cross-section, of a distal endportion the end effector shown in FIG. 8A in a closed state supportingthe needle of FIG. 8A, the needle being shown in a compressed position.

DETAILED DESCRIPTION

Minimally invasive suturing devices in accordance with the presentdisclosure enable the use of a needle that is longer than a width of asuturing device and/or an access device used to deliver the suturingdevice to the surgical site. Delivery of such a relatively long needleis achieved by moving a first portion of the needle relative to a secondportion of the needle in a first direction to reduce a profile of theneedle from a suturing state to an insertion state. In the insertionstate of the needle, the needle can be retained by an end effector ofthe suturing device while the end effector is disposed in a first,insertion position. Once delivered to the surgical site, the needle canbe reoriented to the suturing state, e.g., by moving the first portionof the needle in a second direction relative to the second portion ofthe needle where the second direction is opposite the first direction.When in the suturing state, minimally invasive suturing can be achievedby passing the needle back and forth between opposed jaw members of theend effector in a conventional manner.

For a more detailed description of suitable endoscopic surgical devices,systems, and methods for use with the various end effectors and needlesdescribed herein, reference can be made, for example, to U.S. Pat. No.8,337,515 and to U.S. Patent Application Publication No. 2009/0312773,the entire contents of each of which are incorporated herein byreference. Details of various embodiments of minimally invasive suturingdevices in accordance with the present disclosure will now be describedin detail.

As used in the following detailed description, the term “clinician”refers to a doctor, nurse, or other health care provider and may includesupport personnel. The terms “proximal” or “trailing” each refer to aportion of a structure closer to a clinician, and the terms “distal” or“leading” each refer to a portion of a structure farther from theclinician.

Referring now in specific detail to the drawings, in which likereference numbers identify similar or identical elements, FIG. 1illustrates an endoscopic stitching device, shown generally at 10.Endoscopic stitching device 10 includes a handle assembly 20 with anactuator 22, a trigger 24, and/or other suitable actuating mechanism(e.g., a robot, etc.). As can be appreciated, actuator 22 can be anysuitable slide, knob, button, or the like. An elongate tubular bodyportion 30 extends distally from handle assembly 20 and defines alongitudinal axis “L” that extends through proximal and distal endportions of elongate tubular body portion 30. An end effector 100 issupported on the distal end portion of elongate tubular body portion 30and can be remotely operable by handle assembly 20. End effector 100 isadapted to be particularly useful in endoscopic or laparoscopicprocedures wherein an endoscopic portion of the stitching device, i.e.,end effector 100, is insertable into a surgical site, via an accessdevice (e.g., cannula) (not shown) or the like.

FIGS. 2A-2C illustrate the details of end effector 100. End effector 100has a top-most surface 110 a and a bottom-most surface 110 b and isadapted to move between a closed state (FIG. 2A), a stitching state(FIG. 2B), and an open state (FIG. 2C). In the closed state, endeffector 100 defines a height “h” that is measured between top-mostsurface 110 a and bottom-most surface 110 b. End effector 100 includes afirst jaw member 110 and a second jaw member 120 that are pivotablycoupled by a pin 130. Each jaw member 110, 120 releasably supports asurgical needle such as a surgical needle 200, described in greaterdetail below. As seen in FIGS. 2B and 2C, a suture “S” can be secured tothe needle, using any conventional method, before insertion of endeffector 100 into the surgical site or shortly after insertion of endeffector 100 into the surgical site. For example, the suture “S” can besecured to any of the presently described needles by tying and/orknotting the suture “S” to a respective one of the needles (e.g., bylooping around an outer surface of the respective needle).Alternatively, and or additionally, any of the presently describedneedles can define any number of apertures (not shown) into and/orthrough which suture “S” may be secured.

First jaw member 110 defines a first needle receiving recess 112 andsecond jaw member 120 defines a second needle receiving recess 122. Eachneedle receiving recess 112, 122 is adapted to receive an end portion ofa needle (e.g., needle 200) in releasable friction fit relation. Asillustrated in FIGS. 2A and 2B, upon opening of end effector 100 fromthe closed state to the stitching state, second needle receiving recess122 is dimensioned to cam the surgical needle from an insertion positionor unlocked state, where the surgical needle can be compressed or bent,to a stitching position or locked state, where the surgical needle isextended or elongated and at least temporarily locked.

As described in U.S. Pat. No. 8,337,515 referenced above and as shown inFIGS. 2A and 2C, each of first and second jaw members 110, 120 cansupport a grasping member 160 such as grasping members 162, 164.Grasping members 162, 164 are axially movable, as indicated by arrows“a” and “b,” to enable a needle to be passed back and forth between thefirst and second jaw members 110, 120. More particularly, to enable aneedle to be passed back and forth between first and second jaw members110, 120, each grasping member 162, 164 can releasably engage anopposite end portion of a needle, alternately with the other graspingmember 162, 164. As can be appreciated, any of the presently describedneedles can define a single opening that extends between opposite endportions of the needle, and, in some embodiments, the presentlydescribed needles can define one or more openings on opposed ends of therespective needles such that grasping members 162, 164 can secure aneedle to one of jaw members 110, 120 when a respective one of graspingmembers 162, 164 is engaged with a respective one of the opening(s).

As seen in FIG. 2C, end effector 100 includes a guide member 140 thatdefines an opening 142. With continued reference to FIGS. 2A-2C, guidemember 140 is operatively coupled to second jaw member 120 and isselectively axially movable along second jaw member 120, as indicated byarrow “c,” between proximal and distal positions, including variousintermediate positions. Guide member 140 can be operatively coupled toan actuation mechanism 150. Actuation mechanism 150 includes a shaftmember 152 (e.g., a cable) having a distal end portion that is coupledto the guide member 140 and a proximal end portion that is coupled toactuator 22 (FIG. 1) of the handle assembly 20 such that an actuation ofactuator 22 translates shaft member 152 to cause guide member 140 totranslate between the proximal and distal positions.

In embodiments, actuation mechanism 150 can include any suitablemechanical and/or electrical component adapted to impart axialtranslation to guide member 140. For example, actuation mechanism 150can include any number of springs, levers, gears, cables, electricalcircuitry, and the like that are adapted to cooperate to translate guidemember 140 between the proximal and distal positions.

FIGS. 3A and 3B illustrate an embodiment of a needle, shown generally as200, for use with an end effector of an endoscopic stitching device suchas end effector 100. As depicted in FIG. 2C, each of the presentlydescribed needles, including needle 200, defines a working length “WL”and each is adapted to support a suture “S” for effectuating a suturingprocedure, which, as described above, can be secured to any of thepresently described needles in any conventional manner.

The working length “WL” of the any of the presently described needlescan be any suitable dimension. In some embodiments, the working length“WL” is greater than height “h” (see FIGS. 2A and 2C) of any of thepresently described end effectors in the closed state. In otherembodiments, the working length “WL” is less than or equal to height “h”of any of the presently described end effectors in the closed state.

With reference to FIG. 3A, needle 200 includes a first end portion 210and a second end portion 220 that are operatively coupled together.First end portion 210 includes a first body 210 a having a first tip end210 b and a first support end 210 c. First end portion 210 includes afirst arm 212 that extends from first support end 210 c so as to becantilevered from first end portion 210. First arm 212 may be integrallyformed with, or separately connectable to, first support end 210 c offirst body 210 a. Although shown extending from a central portion offirst support end 210 c, first arm 212 can extend from any suitableportion of first support end 210 c. First arm 212 defines a first pinreceiving passage 212 a and includes a mating or locking feature 214(e.g., a recess, adhesive, protuberance, or the like).

With continued reference to FIG. 3A, second end portion 220 includes asecond body 220 a having a second tip end 220 b and a second support end220 c. Second end portion 220 includes a second arm 222 that extendsfrom second support end 220 c so as to be cantilevered from second endportion 220. Second arm 222 may be integrally formed with, or separatelyconnectable to, second support end 220 c. Although shown extending froma bottom portion of second support end 220 c, second arm 222 can extendfrom any suitable portion of second support end 220 c. Second arm 222includes a mating or locking feature 224 (e.g., a recess, adhesive,protuberance, or the like) and defines a second pin receiving passage222 a that is identical to first pin receiving passage 212 a. As can beappreciated, mating or locking feature 224 of second end portion 220 iscomplementary to mating or locking feature 214.

As seen in FIGS. 3A and 3B, first and second arms 212, 222 of needle 200are positioned in an offset and/or overlapping arrangement and securedtogether by a pin 230 that extends through first and second pinreceiving passages 212 a, 222 a of respective first and second arms 212,222 to enable relative pivotal movement between first and second arms212, 222.

The needle 200 is positionable between a locked state (FIG. 3A) and anunlocked state (FIG. 3B) upon relative pivoting movement between firstand second end portions 210, 220. In the locked state, mating or lockingfeature 214 of first end portion 210 is engaged with mating or lockingfeature 224 of second end portion 220 so that first end portion 210 andsecond end portion 220 are releasably locked together, at leasttemporarily, in an elongated arrangement. In the unlocked state, matingor locking feature 214 of first end portion 210 is disengaged frommating or locking feature 224 of second end portion 220 and one or bothof first and second end portions 210, 220 are adapted to pivot about pin230 relative to the other of first and second end portions 210, 220. Ascan be appreciated, one or both of first and second end portions 210,220 is/are pivoted, away from the other of first and second end portions210, 220, about pin 230, and toward the elongated arrangement toposition needle 200 in the locked state. By comparison, one or both offirst and second end portions 210, 220 is/are pivoted, toward the otherof first and second end portions 210, 220, about pin 230, and away fromthe elongated arrangement.

With reference to FIGS. 4A and 4B, another embodiment of a needle, showngenerally as 300, is provided that can be used with an end effector ofan endoscopic stitching device such as end effector 100. Needle 300includes a pair of end portions 310 connected by a connection portion320 having a pair of opposed ends 320 a, 320 b. Each end portion of thepair of end portions 310 includes a body 310 a having a tip end 310 band a support end 310 c. Each of the opposed ends 320 a, 320 b ofconnection portion 320 is secured to a support end 310 c of one of thepair of end portions 310 to couple the pair of end portions 310together. Connection portion 320 (and/or one or both of end portions310, 320) is formed of a flexible material adapted to enable the pair ofend portions 310 to pivot between an unbent configuration (FIG. 4A) anda bent configuration (FIG. 4B), including various intermediateconfigurations. In embodiments, connection portion 320 (and/or one orboth of end portions 310, 320) can be formed of a shape memory materialsuch as Nitinol or a suitable electroactive polymer. In someembodiments, connection portion 320 (and/or one or both of end portions310, 320) can be adapted to move between the unbent and bentconfigurations in response to changes in temperature and/or inducedstress/pressure.

Needles 200 and 300 can be utilized with any suitable end effector suchas end effectors 40 and 100 to enable the respective end effector tosupport one of the respective needles 200, 300 while maintaining aminimal profile suitable for insertion and/or removal through smallopenings such as, for example, through a 10 millimeter diameter cannula(not shown).

In use, with reference again to FIG. 2A and with particular regard tooperation of needle 200, jaw members 110, 120 of end effector 100 areclosed for insertion so that needle 200, supported by end effector 100,is disposed in an insertion position or an unlocked state. Morespecifically, in the unlocked state, first and second end portions 210,220 of needle 200 are at least partially approximated with first endportion 210 of needle 200 supported in needle receiving recess 112 ofend effector 100 and second end portion 220 of needle 200 supported inneedle receiving recess 122 of end effector 100.

With reference to FIGS. 2A-2C, jaw members 110, 120 of end effector 100can be opened, for example, upon insertion into a surgical site, so thatwhile first end portion 210 of needle 200 is maintained within needlereceiving recess 112 of end effector 100, e.g., by engagement withgrasping member 162, second end portion 220 of needle 200 is drawn fromneedle receiving recess 122 of end effector 100, e.g., while disengagedfrom grasping member 164. With first end portion 210 secured to jawmember 110, opening movement of one or both jaw members 110, 120 of endeffector 100 enables second end portion 220 of needle 200 to pivot aboutpivot pin 230 relative to first end portion 210 of needle 200 as secondend portion 220 cams out of second needle receiving recess 122. As jawmembers 110, 120 move from the insertion state (FIG. 2A) to thestitching state (FIG. 2B), needle receiving recess 122 cams second endportion 220 relative to first end portion 210 until needle 200 iselongated and positioned in the locked state (see FIG. 2B).

Alternatively, and or additionally, guide member 140 can be advanceddistally and/or proximally, for example, upon an actuation of actuationmechanism 150, to engage second end portion 220 of needle 200 (e.g.,with a distal end portion of guide member 140) and provide axial forceto second end portion 220 to facilitate movement of second end portion220 and orient needle 200 into the locked state. As can be appreciated,guide member 140 can be adapted to be translated distally and/orproximally as necessary to facilitate a positioning of needle 200 intothe locked state. Additionally or alternatively, needle 200, in someembodiments, can be oriented from the unlocked state to the locked statewhile simultaneously secured to both jaw members 110, 120 (e.g., withfirst and second end portions at least partially secured withinrespective needle receiving recesses 112, 122 of jaw members 110, 122 bypartially advanced grasping members 162, 164).

Upon positioning needle 200 in the locked state, end effector 100 canthen be used to effectuate a suturing procedure similar to thatdescribed in U.S. Pat. No. 8,337,515 referenced above. For example,handle assembly 20 is actuated to pivot one or both of first and secondjaw members 110, 120 between open and closed states for passing needle200 between jaw members 110, 120 and drawing suture “S” through tissue.More particularly, with needle 200 secured to needle receiving recess112 of first jaw member 110 (e.g., with grasping member 162), anactuation of a trigger 24 (FIG. 1) other actuator of handle assembly 20closes jaw members 110, 120 around tissue so that needle 200 pierces thetissue and is guided into needle receiving recess 122 of the second jawmember 120 to secure needle 140 thereto (e.g., with grasping member 164)and effectuate a first stitch. As can be appreciated, grasping member164 can be distally advanced while grasping member 162 is proximallywithdrawn to effectuate the transference of needle 200 between jawmembers 110, 120. In embodiments, each grasping member 162, 164 can bedistally advanced and/or proximally withdrawn independent of the othergrasping member 162, 164. In some embodiments, grasping members 162, 164can be simultaneously proximally withdrawn and/or simultaneouslydistally advanced.

After completion of the first stitch, jaw members 110, 120 can then beopened again so that needle 200 can be transferred back from second jawmember 120 to the first jaw member 110 in like fashion upon anotherclosing of jaw members 112, 114 to effectuate another stitch. Thisprocess, in whole, or in part, can be repeated as necessary until thetissue is sutured as desired.

Upon completion of the suturing procedure, guide member 140 can bepositioned to receive second end portion 220 of needle 200 withinopening 142 of guide member 140 to facilitate a pivoting movement ofsecond end portion 220 of needle 200 relative to first end portion 210of needle 200 when needle 200 is retained in needle receiving recess 112(e.g., friction fit and/or grasping member 162). For example, whenneedle 200 is disposed in a locked state, second end portion 220 ofneedle 200 can be positioned within opening 142 of guide member 140,such as by translating guide member 140 and/or pivoting jaw members 110,120 of end effector 100 as appropriate. Then, a subsequent sufficientproximal movement of guide member 140 can impart an axial and/orrotational force on second end portion 220 of needle 200 to unlock firstand second end portions 210, 220 of needle 200. Upon unlocking needle200, jaw members 110, 120 of end effector 100 and/or guide member 140can be manipulated as appropriate to reposition first and second endportions 210, 220 within respective needle receiving recesses 112, 122of respective first and second jaw members 110, 120 so that end effector100 can be closed around needle 200 and back into the insertionposition, for example, for removal from the surgical site.

Since the operation of needle 300 is similar to the use of needle 200 asdetailed above, the operation of needle 300 is only described herein tothe extent necessary to describe the differences in operation of needle300. Needle 300 can be positioned in the bent or approximatedconfiguration (FIG. 4B), for example, while supported by an end effectorsuch as end effector 100 or 100, to enable the end effector to maintaina minimal profile during insertion and/or removal to/from a surgicalsite (e.g., through a small surgical or natural opening). Needle 300 canalso be arranged in the unbent or unapproximated configuration (FIG.4A), for example, to effectuate surgical suturing when coupled to theend effector upon being advanced to a surgical site. Due to theflexibility of connecting portion 320 of needle 300, needle 300 can bepositioned between the bent and unbent configurations by a predeterminedpivoting movement of jaw members of any suitable end effector and/or bypredetermined actuation of any guide feature, such as guide member 140of end effector 100. More particularly, needle 300 can be manipulated asnecessary to achieve the minimal profile arrangement between needle 300and the respective end effector supporting needle 300. However,connecting portion 320 has sufficient rigidity to enable needle 300 tobe utilized to perform a suturing procedure.

In temperature responsive embodiments of needle 300, for example, needle300 is biased or urged from the bent configuration to the unbentconfiguration upon being subject to a predetermined temperature such asbody temperature. Once inserted in the body, the temperature responsiveproperties of this embodiment of needle 300 maintain the needle 300 inthe unbent configuration so that needle 300 can be used to effectuate asuturing procedure.

When finished suturing with the temperature responsive embodiment ofneedle 300, removal from the surgical site may be achieved by releasingneedle 300 from both jaw members of one of the presently described endeffectors and separating needle 300 from the end effector (e.g., with aseparate grasping device) so that the end effector may be closed andwithdrawn through the access device separate from needle 300.

As another example, in stress/pressure responsive embodiments of needle300, needle 300 is biased or urged from the bent configuration to theunbent configuration upon being subject to a predetermined stress orpressure such as compressive closure force(s) imparted through an endeffector that is greater than the closure force(s) required toeffectuate a suturing procedure. More particularly, this embodiment ofneedle 300 has sufficient rigidity to effectuate a suturing procedure;however, this embodiment of needle 300 will bend upon an application ofa predetermined amount of compressive closure force(s) that is greaterthan a rigidity threshold of the needle that is suitable for suturing.Thus, to remove from the surgical site when finished suturing,compressive closure forces can be applied to this embodiment of needle300 that are greater than the closure forces required for suturing tothereby bend this embodiment of needle 300 back into the bentconfiguration to enable the end effector to achieve the minimal profilerequired during insertion. This minimal profile will enable asimultaneous removal of this embodiment 300 and the end effector.Alternatively, and/or additionally, this embodiment of needle 300 can bereleased from the end effector so that each is separately withdrawn asdescribed above.

FIG. 5 illustrates another embodiment of an end effector, showngenerally as 400, supporting another embodiment of a needle, showngenerally as 500 and described in greater detail below. End effector 400is substantially similar to end effector 100 and is only describedherein to the extent necessary to describe the differences in operationand construction. End effector 400 is adapted for use with an endoscopicstitching device and includes a first jaw member 410 and a second jawmember 420 that are pivotally connected. First jaw member 410 defines afirst needle receiving recess 412 and second jaw member 420 defines asecond needle receiving recess 422. First and second jaw members 410,420 are adapted for relative movement between open and closed states foreffectuating a suturing procedure, for example, by passing needle 500,with suture “S” coupled to needle 500, back and forth through tissuebetween first and needle receiving recesses 412, 422 of respective firstand second jaw members 410, 420 similar to that described above withrespect to end effector 100 and needle 200.

As seen in FIGS. 6A-6C, needle 500 includes a first end portion 510 anda second end portion 520. First end portion 510 includes a connectingend 510 a, an opposed tip end 510 b, and an outer surface 510 c. Amating recess 512 is defined in connecting end 510 a. Mating recess 512may be formed in any suitable shape (e.g., circular and non-circularcross-sections including any polygonal shape). Tip end 510 b is adaptedto be releasably received within needle receiving recess 412 of endeffector 400. Second end portion 520 includes a connecting end 520 a, anopposed tip end 520 b, and an outer surface 520 c. A mating protuberance522 (e.g., bump, nub, rod, etc.) is located on connecting end 520 a ofsecond end portion 520. Mating protuberance 522 is complementary to(e.g., keyed to) mating recess 512 of first end portion 510. Inembodiments, first end portion 510 includes a mating protuberance andsecond end portion 520 defines a mating recess.

In an insertion position, as seen in FIG. 6A, first and second endportions 510, 520 of needle 500 are supported by end effector 400 in afirst, laterally misaligned configuration. End effector 400 can includea pair of grasping members (not shown) similar to grasping members 162,164 described above. Each grasping member of the pair of graspingmembers is adapted to engage one of first and second end portions 510,520 such that the pair of grasping members simultaneously support bothfirst and second end portions 510, 520 during insertion into a surgicalsite.

In the laterally misaligned configuration, tip ends 510 b, 520 b ofrespective first and second end portions 510, 520 of needle 500 aresecured within respective needle receiving recesses 412, 422 of endeffector 400 and disposed in longitudinally aligned relation to oneanother, while connecting ends 510 a, 520 a (and respective matingrecess and protuberance 512, 522) of respective first and second endportions 510, 520 of needle 500 are separated and disposed inlaterally-adjacent relation with one another with each end portion 510,520 imposing a lateral force on the other to maintain first and secondend portions 510, 520 in the misaligned configuration. Further, in themisaligned configuration, connecting end 510 a of first end portion 510can be closer to second jaw member 420 than first jaw member 410 andconnecting end 520 a of second end portion 520 can be closer to firstjaw member 410 than second jaw member 420. In addition, connecting ends510 a, 520 a of respective first and second end portions 510, 520 can bespaced apart such that outer surfaces 510 c, 520 c of respective firstand second end portions 510, 520 are disposed in contacting relationwhen first and second end portions 510, 520 are misaligned. Althoughfirst end portion 510 is shown left (when viewed from the front ofdevice) of second end portion 520 in the insertion position, second endportion 520 can be positioned left of first end portion 510 in theinsertion position.

With reference to FIG. 6B, first and second jaw members 410, 420 can beunapproximated (as indicated by arrows “e”), for example, subsequent toan insertion, so that first and second end portions 510, 520 are drawnapart until disposed in spaced-apart relation. By virtue of beingspaced-apart, first and second end portions 510, 520 no longer imposelateral forces on one another, enabling first and second end portions510, 520 to rotate about the respective first and second jaw members410, 420 in opposite radial directions until aligned with one anotherrelative to the longitudinal axis. When first and second end portions510, 520 are aligned relative to the longitudinal axis, mating recess512 and mating protuberance 522 of respective first and second endportions 510 are longitudinally aligned.

As seen in FIG. 6C, first and second jaw members 410, 420 can then beapproximated (as indicated by arrows “f”), connecting first and secondend portions 510, 520 via respective mating recess and protuberance 512,522. The connection of first and second end portions 510, 520 formsneedle 500 into a unitary arrangement suitable for use in a suturingprocedure. To effectuate the suturing procedure and pass needle 500 backand forth between first and second jaw members 410, 420, the graspingmembers are movable in alternate distal and/or proximal relationrelative to one another and first and second jaw members 410, 420 aremoveable between open and closed states.

Upon completion of the suturing procedure, needle 500 can be releasedfrom end effector 400 so that each is separately withdrawn as describedabove with respect to the temperature responsive embodiment of needle300.

Rather than having end portion 510, 520 oriented in offset lateralrelation, the end portions of the needle may be oriented in longitudinaloffset relation as shown in the embodiment of FIG. 7. FIG. 7 illustratesanother embodiment of a needle, shown generally as needle 600 positionedin end effector 400 in an insertion position. Needle 600 issubstantially similar needle 500 and is only described herein to theextent necessary to describe the differences in construction andoperation of needle 600. Needle 600 includes a first end portion 610 anda second end portion 620. First end portion 610 has a connecting end 610a and a tip end 610 b. Connecting end 610 a includes a matingprotuberance 612. Second end portion 620 has connecting end 620 a and atip end 620 b. Connecting end 620 a of second end portion 620 includes amating recess 622 that is complementary to mating protuberance 612 offirst end portion 610. In the insertion position, connecting ends 610 a,620 a (and respective mating protuberance and recess 612, 622) ofrespective first and second end portions 610, 620 are disposed inlongitudinally adjacent relation to one another, while tip ends 610 b,620 b are disposed in longitudinally aligned relation to one another.Although first end portion 610 is shown proximally of second end portion620 in this insertion position, second end portion 620 can be positionedproximally of first end portion 610 in this insertion position.

In use, similar to that described above with respect to needle 500, endeffector 400 can be moved between an open or unapproximated position anda closed or approximated position to couple first and second endportions 610, 620 into a unitary arrangement that forms needle 600.Needle 600 can then be utilized to effectuate a suturing procedure asdescribed above with respect to needle 500 and end effector 400. Uponcompletion of the suturing procedure, needle 600 and/or end effector 400can be removed from the surgical site as described above with respect toneedle 500 and end effector 400.

As can be appreciated, although the embodiments of first and second endportions of needles 500 and 600 are shown positioned in offset lateral(FIG. 6A) and/or longitudinal (FIG. 7) relation in the respectiveinsertion positions of needles 500, 600, any of the first and second endportions, or portions thereof, of the needles 500, 600 can be disposedin any suitable relation to any opposed first and/or second end portion,or portions thereof, of the needles 500, 600, including laterally,longitudinally, and/or combinations thereof.

FIGS. 8A and 8B illustrate another embodiment of an end effector, showngenerally as 700, that supports another embodiment of a needle, showngenerally as 800. End effector 700 is substantially similar to endeffectors 40 and 400 and is only described herein to the extentnecessary to describe the differences in operation and construction ofend effector 700. End effector 700 is adapted for use with an endoscopicstitching device and includes a first jaw member 710 and a second jawmember 720 that are pivotally connected. First jaw member 710 defines afirst needle receiving recess 712 and second jaw member 720 defines asecond needle receiving recess 722. First and second jaw members 710,720 are adapted for relative movement between open and closed states foreffectuating a suturing procedure.

As seen in FIG. 8A, needle 800 is adapted to support a suture “S” andincludes a first end portion 810, a second end portion 820, and acompressible element 830 supported between first and second end portions810, 820 to enable second end portion 820 to slidably translate throughfirst end portion 810 (as indicated by arrow “g”), relative to first endportion 810, between a first, compressed position and a second, extendedposition. The compressible element 830 can be adapted to bias first andsecond end portions 810, 820 towards the extend position. First endportion 810 has an outer surface 810 a and an inner surface 810 b. Innersurface 810 b defines a cavity 810 c. Cavity 810 c is dimensioned tosupport compressible element 830. First end portion 810 includes a tipend 812 and a support end 814. Second end portion 820 has an outersurface 820 a and includes a tip end 822 and a support end 824.Compressible member 830 is formed of a compressible material andincludes a first end 830 a and a second end 830 b. First end 830 a issecured to a trailing end of support end 824 of second end portion 820in a leading end portion of cavity 810 c. Second end 830 b is secured toa trailing end portion of cavity 810 c adjacent to tip end 812 of firstend portion 810. Compressible member 830 can include a spring. Inembodiments, compressible member 830 includes gas.

An approximation of first and second jaw members 710, 720 of endeffector 700 compresses needle 800 from an extended position (FIG. 8A)to a retracted or compressed position (FIG. 8B). In the compressedposition, needle 800 enables end effector 700 to maintain a minimalprofile for insertion and/or removal of end effector 700 and needle 800through a small opening. In the extended position, needle 800 can beused to effectuate a suturing procedure.

Any of the components of the presently described devices can be formedof any suitable metallic and/or polymeric material. Securement of any ofthe components of the presently described devices to any of the othercomponents of the presently described devices can be effectuated usingknown fastening techniques such welding (e.g., ultrasonic), crimping,gluing, etc.

Persons skilled in the art will understand that the structures andmethods specifically described herein and shown in the accompanyingfigures are non-limiting exemplary embodiments, and that thedescription, disclosure, and figures should be construed merely asexemplary of particular embodiments. It is to be understood, therefore,that the present disclosure is not limited to the precise embodimentsdescribed, and that various other changes and modifications may beeffected by one skilled in the art without departing from the scope orspirit of the disclosure. For example, when finished using the presentminimally invasive suturing devices, removal from the surgical site maybe achieved while one of the presently described needles is secured toone of the presently described end effectors by sequentially pulling theaccess device and the end effector out of the incision in the patient'sskin, with the access device being removed first (while remainingsupported about the shaft of the suturing device) and the end effectorbeing removed second. More particularly, with the access device removed,the end effector can be readily drawn through the incision since thepatient's skin will have sufficient elasticity to enable removal of theend effector without reducing the height of the end effector. Subsequentto the removal of the end effector through the incision, the accessdevice can be removed from the suturing device by advancing the accessdevice off of the distal end of the end effector.

Additionally, the elements and features shown or described in connectionwith certain embodiments may be combined with the elements and featuresof certain other embodiments without departing from the scope of thepresent disclosure, and that such modifications and variations are alsoincluded within the scope of the present disclosure. Accordingly, thesubject matter of the present disclosure is not limited by what has beenparticularly shown and described.

What is claimed is:
 1. An endoscopic stitching device, comprising: anend effector including a first jaw member and a second jaw member, thefirst jaw member movable relative to the second jaw member between anopen state and a closed state; and a needle removably coupled to the endeffector and configured to alternate between the first jaw member andthe second jaw member of the end effector, the needle including: a firstend portion and a second end portion, each of the first and second endportions of the needle releasably engageable with a respective one ofthe first and second jaw members of the end effector; and a connectingportion disposed between the first and second end portions, theconnecting portion configured to enable the first end portion to moverelative to the second end portion between approximated andunapproximated positions as the first and second jaw members movebetween the open and closed states, wherein the connecting portion ofthe needle includes a first arm member that extends from the first endportion of the needle and a second arm member that extends from thesecond end portion of the needle, the first arm member secured to thesecond arm member by a pivot pin, the first end portion configured topivot about the pivot pin relative to the second end portion.
 2. Theendoscopic stitching device of claim 1, wherein the first arm member ofthe needle includes a protuberance and the second arm member of theneedle includes a recess, the protuberance and the recess configured toselectively engage each other to at least temporarily lock the first andsecond end portions of the needle in an aligned configuration.
 3. Theendoscopic stitching device of claim 1, wherein the needle includes atleast one of a metallic or polymeric material.
 4. An endoscopicstitching device, comprising: a first jaw member; a second jaw member,the first and second jaw members positioned to move between open andclosed states; and an endoscopic stitching needle configured toalternate between the first jaw member and the second jaw member, theneedle comprising: a first end portion configured to releasably engagethe first jaw member; and a second end portion configured to releasablyengage the second jaw member; a connecting portion joining the first andsecond end portions, the connecting portion configured to enable thefirst end portion to move relative to the second end portion betweenapproximated and unapproximated positions as the first and second jawmembers move between open and closed states, wherein the connectionportion includes a first arm member and a second arm member, the firstand second arm members configured to selectively engage one another toselectively lock the first and second end portions in a firstconfiguration.
 5. The endoscopic stitching device of claim 4, whereinthe first arm member extends from the first end portion and the secondarm member extends from the second end portion, the first arm membersecured to the second arm member by a pivot pin, the first end portionconfigured to pivot about the pivot pin relative to the second endportion.
 6. The endoscopic stitching device of claim 5, wherein thefirst arm member includes a protuberance and the second arm memberincludes a recess, the protuberance and the recess configured toselectively engage each other to move the first and second arm membersbetween locked and unlocked positions.
 7. The endoscopic stitchingdevice of claim 6, wherein the first and second arm members are in thelocked position when the protuberance is engaged with the recess, andthe first and second arm members are in the unlocked position when theprotuberance is disengaged from the recess.
 8. The endoscopic stitchingdevice of claim 4, wherein the needle includes at least one of ametallic or a polymeric material.
 9. The endoscopic stitching device ofclaim 4, wherein the first arm member includes a protuberance and thesecond arm member includes a recess, the protuberance and the recessconfigured to selectively engage one another.
 10. The endoscopicstitching device of claim 9, wherein the first and second end portionsare selectively locked together when the protuberance is received withinthe recess.
 11. The endoscopic stitching device of claim 10, wherein thefirst and second end portions are aligned with one another when lockedtogether.
 12. The endoscopic stitching device of claim 4, wherein thefirst configuration is an aligned configuration.
 13. The endoscopicstitching device of claim 4, wherein the first and second arm membersare pivotably coupled together.